In order for a patient to be eligible for hospice care the person’s primary physician must certify that the patient has an advanced disease or combination of diseases which will limit their life to 6 months or less, if the disease follows its natural course. The Hospice Medical Director must also certify terminal status of the patient, based on Medicare standards, before they can be admitted to the program. This process can be lengthy if the documentation in the medical record does not support the terminal status or if the primary physician chooses a diagnosis that does not fall within Medicare guidelines for Hospice admission.
*The determinants within these guides should not take the place of a physician’s clinical judgment.
Heart Disease/CHF (Congestive Heart Failure)
Neurological Diseases (see list below)
ALS (Amyotrophic Lateral Sclerosis)
MS (Multiple Sclerosis)
Pulmonary Disease/COPD (Chronic Obstructive Pulmonary Disease)
Renal (Kidney) Failure
Frequent Co-Morbidity documentation requirements
Cachexia/Protein Calorie Malnutrition (Weight Loss)